The surveillance of growth and pubertal development plays an integral role in the health maintenance of all children. For children with disabilities, including cerebral palsy (CP), there is little scientific data on nutrition, growth, and maturation. This proposal's hypotheses are: a) the timing and tempo of sexual maturation in children with CP differs from the normal population, and b) nutritional and hormonal mechanisms are responsible for these differences in sexual maturation. The specific aims of the study are: 1) To determine the interactions among nutrition, adiposity, hormones, and the onset and progression of puberty in children wit moderate-severe CP; 2) To determine the changes in nutritional status, linear growth, sexual maturation, and skeletal maturation over one year in a representative sample of children with CP; and 3) To compare the onset and progression of puberty and the hormonal influences controlling these processes in children with CP to a reference group of normally growing children in a cross sectional and longitudinal matched-pairs design.